I just was curious to see if anyone has ever dealt with this issue. I went in for my first OB/Gyn appt. (the one where they run all the tests) in September. This is my 3rd child but it was the first time I was ever asked if I wanted to be tested as a carrier for Cystic Fybrosis (CF). I have a friend who has a child with CF so I said, sure why not, is there any down side to it or is it just another test? The doctor and nurse both assured me this was the case, it was just another test. Well today I just got my EOB from my insurance and it turns out that it is a $1000 blood test. That means, with insurance, I am out over $600 for getting this test (which thankfully I tested negative). My problem is that nobody ever mentioned that the test was so expensive and I would never have had it if I thought that it would have cost so much. Nowhere on the forms did it mention how much it might be, and no one in the office shared this information.
So my question is, do I have any kind of case to make with the doctor's office about this? I'm furious that no one told me that it would cost this much, and even though the lab company did the actual charging, the doctor's office would have known that it would be expensive. I'm not even sure if I can ask for them to do anything about it, so I wondered if anyone has ever dealt with this and had anything positive/negative come out of it? TIA
Update: Thanks so much for the responses so far, it is helpful to know at least there are others who have been in my shoes! Just to clarify though, I am curious to know how to talk to the doctor's office about this - that I feel they should let people know if a test is above and beyond what is normally expected. I know the insurance actually wrote off about $400 of the amount (bc it is in-network) so I won't have to pay the whole amount but my issue is that I go in for routine bloodwork which in the past has cost maybe up to $100 for each test and out of the blue, one test is $1000 - I had no way of knowing that there would be a different cost. I don't think any "layperson/nonmedical person" would guess that. Yes, in the future, I now know to ask specifically how much something will cost, but I think that since I did ask the doctor and nurse if there is any downside to the test, ethically I feel they should have mentioned, "it's more expensive than other tests". (Realistically, I feel I won't get anywhere with this, but it is helpful for me to hear your input! So thanks!)
I agree with Sarah. As she said, if you do not go in guns blazing, they might be willing to work with you. The worst that can happen is that they will say "no".
Unfortunately many offices will say that it is up to you to know the insurance coverage that you have and that it is not their responsibility to tell you or to know what your coverage is. Your best bet is to try the sympathy angle when you call the lab. Tell them you didn't know it was going to cost that much and you are wondering if there is a way for them to reduce their part of the bill (you can't afford, need a payment plan etc) it -most offices/labs have a sliding scale policy of some sort even if it's not public knowledge.
You might even try having the dr's office call the lab on your behalf and see if they can get something worked out for you (I have actually done this for patients but its very rare that the situation warranted the dr allowing the call) Maybe this gives you some ideas-good luck
The short answer is: it sucks but you are just out the money. I have learned the hard way that it is OUR responsibility to ask questions and make sure all tests that are ordered are required tests, then double and triple check everything. Also make sure the lab you're going to is covered under your insurance (I have in-network and out-of-network lab places, so I have to pick the in-network ones to receive benefits). The doctor's office probably did tell you it's an optional test but may have recommended it. It is our job to say YES or NO to any medical treatment. Doctors can't force us to get any type of treatment so ultimately it is our choice whether or not to receive care, and we have to pay for that care, even if we don't have all the facts.
You can talk to your doctor about it but I'm sure you'll get nowhere. My advice would be to just consider this a lesson learned for the future.
I had a similar roblem when our pediatrician ran a blood work on daughter that ended up costing hundreds of uninsured money. I was not happy.
I do not agree with the poster that says it would not be right for you to even approach the doc about it. Of course it's ok and your doc should have knowledge that particular tests are expensive or otherwise not usually covered. Other than that last one mentioned our docs have always warned us. On that test the doc apologized and fixed it somehow.
Looks like you have a lot of good info here and I don't have time to read them all, but a couple of things: First, find out what the specific parameters are for your insurance to cover the test, make sure the Dr. used the correct code when they submitted, raise holy hell with the Dr. office about not being told this would be an added expense (I have successfully gotten a Dr. to eat his fees for not telling me upfront about them). Good luck - I do hope you are able to work it out. And from now on, check everything!! My Dr. was billing me for every sono I had, abut when I called my insurance, I found out it was covered 100% so the Dr. had to credit my account. They make mistakes too!!!
E.,
It all depends on what kind of policy you have. Usually the insurance company "contracts" with the doctor to pay a certain price for the test. That's what they pay. Look at your insurance statement:
it should say something like amt billed, not covered, and covered. We have BC & BS and Aetna in our family . The not covered always has a note, "the amount billed is greater than the amount allowed for this service. You will not be billed for this amount.
One policy says that for certain procedures, insurance pays 90%, I pay 10%. So example: the $1000 test, they cover $600 of the fee and they pay $540 and I pay $60. I am not billed for the remainder. The doctor is contractually obligated to accept $600 for the service. They write the rest of it off.
Every insurance is different, but if the $600 is the contracted price, that is all you should have to pay. That should also be the same case with the lab. I am looking at a bill from quest diagnostics (a lab) and it has the same columns.
I agree w/ Julie. What's on the EOB is not necessarily what you owe. Generally, the insurance company will have a negotiated rate for each procedure or test. These rates are often half (or MORE) of what is their rack-rate (or what they charge the uninsured - which is total BS - but that's a whole other soap-box :-)). Make sure you are looking at the negotiated rate, and NOT the standard rate. Some EOB's are clearer than others. When I was PG 2+ yrs ago, I was considered high risk so I had every test on the planet run and I NEVER paid any crazy amount. I looked closely at every EOB, tho, just to see where all the money went. I would often see things like this.....
Procedure Cost: $1,000.00
BCBS Negotiated Rate: $300.00
Insurance Covered: $240.00 (80% of negotiated rate)
You Owe: $60.00 (20% of negotiated rate).
Good Luck!!
No, there is nothing you can do. You will have to pay for it. You should have asked how much it cost when it was first discussed and presented to you. That is your responsibility. And you should not expect the doctor or lab to make any accommodation about it. You had the test done and recieved the results, you owe the money. Sorry it happened like that, but the reality is that the bill is your responsibility to pay and it would not be right for you to even approach them about it.
Hi E., I had the exact same thing happen to me - wonder if it was the same doc? It was so frustrating and at the time, I did not have insurance, so I had to pay the entire $1200 bill for bloodwork. No one ever mentioned to me that bloodwork would be that expensive. I complained to the doctor's office and the lab but got nowhere and eventually had to pay. I switched doctors immediatley after that and told them this was the reason why. You should definitely tell the nurse at your doctor's office how you feel (the front desk staff wont' care) and even consider changing doctors. I'm so sorry you had to deal with this too!
It wouldn't hurt to make a few calls. I had something similar happen with some bloodwork. It cost hundreds of dollars and sounded like something that should have been covered by my insurance but was not. The docs office contacted the lab and had the bill sent to them instead of me. If I got billed it was over $400, if they got billed, it was less than $20. I'm not saying they can do that for you, but it's worth a shot.
I will say that often the doctors don't know how much some of that stuff costs. Their job is to treat you, the front office handles the insurance. But this is one of those things that they should be made aware because that is a staggering amount of money to be billed for an optional test.
Sorry, but I think it's a lost cause. Unfortunately, these are the questions you should have asked before the testing, including contacting your insurance company to make sure the test would be covered. Don't get me wrong, I do believe it's a doctor's obligation to be as informative as possible, but we also owe it to ourselves to be as inquisitive as possible. I've been burned in a similar manner, so I feel your financial pain!
Unfortunately, each insurance plan is different for how much the insurance company allows to be charged and how much they reimburse. Just to ease your own frustrations, I would ask to talk to the patient advocate about your issues. Although they should have told you of the charges(ethically), they have no legal obligation to do so. Basically, the most that is going to come out of you telling the patient advocate that you were upset is that they might in the future try to include an estimate/pre-approval from insurance about how much it will cost/cover.
Good luck.
Hi E.,
I would try calling your insurance company first. They can tell you first of all 1)if they ever received the bill and 2)if they did, why they denied it.
Sometimes it is a matter of miscoding. A CF test during pregnancy is a common thing, and maybe the lab didn't code that you were pregnant.
It is definitely worth a call to your insurance company. And, being nice to the insurance company when you call can also help immensely. Also, if you don't "gel" with the first person you talk to, you can just hang up and call back and you will get someone different.
Just my two cents,
R. B.
I think you could ask/tell your Dr's office that you had no idea that this test was so expensive and that while you know each person's insurance is different and the dr's office can't possibly know whose insurance would cover what, they do probably have an idea of what is usually covered and which tests cost more. You can then suggest that if there is a way to put maybe a list of all the possible tests on a paper. Put a star by the ones the Dr. office requires, and a dash by the ones that are optional. They could also put the cost of the tests (before insurance discounts) and then people could decide. They could decide then and there or call their insurance and get the proper info for making that decision. Tell them it's just a decision b/c you found yourself in a position where you had to pay a lot more out of pocket and you felt like they should have mentioned that it cost more.
Did you actually get billed yet for this?? The insurance EOB - explanation of benefits and what you owe are NOT necessarily the same. Some things get "written" off by the doctor and they don't bill you... I had that with a procedure that my office cost was $275 - then my EOB came saying I owed $4500 for it - when I called the doctor - they said I would NEVER be billed for that b/c that was not what was contracted but that is how insurance works. I would not fret yet... check with your doctor's office.
Unless, of course you have been billed - then ignore all the above!
Sorry!
I agree with the majority here, and also wanted to add that I had a conversation with my doctor several years ago. We had switched insurance and my ob was no longer on the plan, but I liked him enough to pay for an office visit. When I told him I was paying cash he OFFERED a discount that left me paying less than my copay the year before. He said that they have to carefully price their services so that they get enough out of insurance to actually cover their expenses. SO it absolutely doesn't hurt to ask if there is anything they can do. Especially if you calmly explain the situation there is probably some wiggle room in there. Good luck!
Well, unfortunately they don't know the coverage plan of each patient so it requires someone checking coverage/cost. If the doctor's office doesn't do it then you may have to. In my situation, I had to call Blue Cross/Blue Sheild to determine if it was covered. I got the CPT code from the office to determine. After determining that my plan did not cover, I called the office to detmine the cost. We decided against it b/c of the expense. This also happened with the birth control that I was considering. I can't remember the name; however, my insurance plan did not cover. We determined the cost based on what the office told us - it was going to be $1,000; so I decided against. Did you ask the about cost prior to getting? They should have at least had you sign something stating that you would be responsible for payment if insurance did not cover. That is common practice for some offices. Not sure if that helped. Good luck!
One more thing, I remember that my insurance plan did cover if I was considered high risk; however, I was not. Maybe you could determine what the parameters are for coverage from your insurance. Then have your physcian write a letter of medical necessity and send to your insurance company. Remember they try everything not to pay; so there may be a window of opportunity if you want to try and fight with your insurance.
